Thromboangiitis Obliterans (Buerger Disease)

Thromboangiitis Obliterans (Buerger Disease) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • One of the causes of critical limb ischemia
  • Nonatherosclerotic vasculitis of small- and medium-sized arteries and veins resulting in segmental occlusion of the distal extremity vasculature; caused by inflammatory thrombo-occlusive disease
  • Characterized by resting pain, ischemic ulcerations, and gangrene of the digits of hands and feet
  • Patients are typically young (age <50 years), male smokers.
  • Synonym(s): Buerger disease

Epidemiology

  • The prevalence has decreased in North America over the past 30 years.
  • Most prevalent in Eastern Europe, Mediterranean, and Asian countries

Incidence
  • 11 to 30/100,000 persons per year
  • Predominant age: 20 to 40 years
  • Predominant sex: male > female; increasingly diagnosed in women, perhaps due to increased smoking
Prevalence
  • Estimates range from as low as 0.5–5.5% in Western Europe, to 45–63% in India, to 80% in Israel among those of Ashkenazi ancestry.
  • Accounts for 5% and 16% of patients hospitalized for arterial occlusive disease in Europe and Japan, respectively
  • 13/100,000 U.S. population
  • Overall occurrence is decreasing worldwide.

Geriatric Considerations
Not common in the elderly

Pediatric Considerations
Consider in adolescent smokers presenting with claudication, digital ulcers, or digital gangrene; rare in children

Etiology and Pathophysiology

  • Thromboangiitis obliterans (TAO) is idiopathic in nature. Demonstrates impaired endothelium-dependent vasorelaxation and decreased peripheral sympathetic outflow. Nonendothelial mechanisms of vasodilation are intact.
  • Segmental infiltration of inflammatory cells in vessel wall leads to thrombotic occlusion.
  • Highly cellular and inflammatory thrombus with relative sparing of the blood vessel wall
  • Smoking predisposes to occurrence.
  • Genetic factors implicated
  • Autoimmune component which is not fully understood
  • Chronic anaerobic periodontal infection

Genetics
  • Greater prevalence of HLA-A54, HLA-A9, and HLA-B5
  • HLA-B12 antigen may be associated resistance to disease.
  • Familial cases rarely reported

Risk Factors

  • Smoking as little as 1 to 2 cigarettes daily, chewing tobacco, snuff, and nicotine replacement are all risk factors for TAO.
  • Chronic anaerobic periodontal infection also may play a role in the development of TAO.

General Prevention

Tobacco cessation

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